{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T22:38:23Z","timestamp":1777761503840,"version":"3.51.4"},"reference-count":74,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Aortic valve stenosis (AS) is assessed by echocardiography in clinical practice. Conventionally, the aortic valve area, peak transaortic valve velocity\/gradient and the mean transvalvular gradient determine if the AS is categorized as mild, moderate or severe. Recently, the entity of paradoxical low-flow, low-gradient AS despite normal left ventricular ejection fraction (LVEF) was described and flow (as determined by stroke volume indexed to body surface area) was used to further categorize AS. The new European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) guidelines in 2025 recommended a new phenotype-based classification, which improved the prognostication of AS. There are now five phenotypes: (1) concordant high-gradient AS; (2) low-flow, low-gradient AS with reduced LVEF; (3) low-flow, low-gradient AS with preserved LVEF; (4) normal-flow, low-gradient AS with preserved LVEF; and (5) discordant high-gradient AS. These appear to have different underlying pathophysiology, and hence prognostication and therapy. In addition, categories of AS in the setting of reduced LVEF are further divided based on their responses to dobutamine or exercise stress, which may result in different therapeutic strategies. In the transaortic valvular replacement (TAVR) versus the surgical aortic valve replacement (SAVR) era, the classification of these AS groups may have differing implications on the appropriate interventions. Furthermore, there are investigations on the effect of AS on the left ventricle and other chambers and stages of AS based on the extent of cardiac damage, which may have important prognostic value post-AVR. On the other spectrum, there are new developments in imaging analysis, such as using artificial intelligence. This state-of-the-art paper will comprehensively review the important updates in AS and its clinical implications.<\/jats:p>","DOI":"10.3390\/medicina62050819","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T13:32:22Z","timestamp":1777469542000},"page":"819","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Categories of Aortic Stenosis: What\u2019s New and the Clinical Implications"],"prefix":"10.3390","volume":"62","author":[{"given":"Jamie Sin Ying","family":"Ho","sequence":"first","affiliation":[{"name":"Department of Medicine, National University Hospital, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerlyn Zhixuan","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Medicine, National University Hospital, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron Kwun Hang","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Medicine, National University Hospital, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3659-1650","authenticated-orcid":false,"given":"Aloysius S. T.","family":"Leow","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8101-6391","authenticated-orcid":false,"given":"Joy Yi-Shan","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swee Chye","family":"Quek","sequence":"additional","affiliation":[{"name":"Division of Paediatric Cardiology, Department of Paediatrics, Khoo Teck Puat-National University Children\u2019s Medical Institute, National University Hospital, Singapore 119074, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4338-3876","authenticated-orcid":false,"given":"Andrew Fu Wah","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Singapore General Hospital, Singapore 168581, Singapore"},{"name":"Prehospital Emergency Research Center, Duke-NUS Medical School, Singapore 169857, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2764-2869","authenticated-orcid":false,"given":"Ching Hui","family":"Sia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1742-3061","authenticated-orcid":false,"given":"Hoai Thi Thu","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Vietnam National Heart Institute, Bach Mai Hospital, Hanoi 10000, Vietnam"},{"name":"Department of Internal Medicine, VNU-University of Medicine and Pharmacy, Hanoi 10000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiong Cheng","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3515-7924","authenticated-orcid":false,"given":"Kian Keong","family":"Poh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/j.jacc.2013.05.015","article-title":"Aortic Stenosis in the Elderly: Disease Prevalence and Number of Candidates for Transcatheter Aortic Valve Replacement: A Meta-Analysis and Modeling Study","volume":"62","author":"Osnabrugge","year":"2013","journal-title":"J. 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